Sunday, 25 March 2012

Daily routine of a houseman

To those who aren't housemans, have you ever wondered what's the daily routine of a houseman like? Well, let me give you an insight into a typical day of a houseman. Medical students pay attention! Cos this will be the shit that you're going to have to put up through every single day for 2 friggin' years once you graduate.

5.30am: Wake up, get ready for work. If you wanna have breakfast, wake up earlier.

6.15am: Leave the house. Reach hospital usually in 15-20mins.

6.30am: Find a parking space, punch in around 6.45am, then go to your respective ward.

6.50am: Check the whiteboard to see the list patients you have been assigned to. Pray hard that you dont get a complicated case.

7.00am: On average, there are about 5 HO and 5 nurses in a ward, but there are only 5 computers. If you're lucky, you can straight away use the computer to see what's the history of the patient. If not, wait for your turn. Print out the history, jot down the trend of the vital signs, laboratory investigations, imaging results, current medications, patient's progress overnight, and latest plan of management. Find patient's medication chart to confirm the list of drugs and current doses, and if there are any procedures planned, make sure the consent form is filled up and signed by the patient. Go to the bedside to check up on your patients, get relevant information and history as required, and do a quick clincical examination. Bear in mind that you don't always get co-operative patients.

7.30am: MO will start their rounds around this time. If you havent finished reviewing your patients by this time, then be prepared for some scolding. Even if you finished reviewing your patients, you're gonna get scolded one way or another, either because you missed some minor details, or forgot to carry out some orders. etc. If the current plan of management is wrong, despite the plan being ordered by another MO, and clearly it's not your fault, you're gonna get scolded anyway.

8.00am: Carry out orders after the MO rounds. Blood taking, insert branula, update patient's bedside folder, order medications, request for imaging procedures, refer cases to other department, etc.

8.45am: Specialist rounds. Present the history, findings on admission, current findings, current issues, latest medication and investigation, vital signs and their trend, and latest plan of management. Get scolded again, and this time by both the specialist and MO.

11.00am: Finished specialist rounds. Carry out new orders. If there are new cases, you need to clerk them.

12.00pm: Finished carrying out the orders. Enter the notes for the morning rounds. Wait for your turn to use the computer again.

12.45pm: Done entering notes. Grab something from cafeteria and have a quick lunch. Sometimes you might finish carrying out the orders and entering notes as late as 2.00pm. By 'sometimes', I mean about 3 to 4 days per week. If you finish lste, then you wont have the time for lunch.

1.45pm: Review patients again and prepare for the afternoon rounds with MO.

2.30pm: Afternoon rounds with MO.

3.30pm: Carry out orders for afternoon rounds. Enter notes for afternoon rounds.

4.00pm: Occasionally specialist will do afternoon rounds as well, usually around this time.

4.30pm: Carry out orders. Enter notes.

5.00pm: Clerk new cases, help others take blood, do procedures, whatever. You can't be seen sitting around doing nothing. If you're a junior, simple procedures might take up to 1 hour. If you're a senior, please guide your juniors.

6.00pm: Pass over case to the evening shift HOs. I usually finish around 6.30pm.

6.30pm: Punch out. Drive back home.

7.00pm onwards: Do whatever you want. Sometimes you need to prepare for seminars and other presentations, sometimes you need to study for your assessment. Some department are using the BD shift system, which means some of you can't go back and have to stay at the hospital until 12 midnight, or come back to work at 11pm and work until 2pm the next day.

So there you go, a brief outline of a houseman's daily routine. There are days you need to work evening or night shifts, so the routine is a bit different. And the shift system will mess up your body's circadian rhythm, so you hardly get any sleep prior to your night shifts.

Common responses you get when you say "I wanna quit!"

Just wanna share some of the common responses that I usually get when I tell people that I wanna quit my housemanship.

"Kau serius ke bro? Jangan la macam ni.. Rilek la dulu. Kalau ade ape-ape hal kita boleh bincang.."

"OMG! Are you serious? You're such a good houseman Danny. I'm sure you can make it through."

"Kau serius ke beb? Kau ok la beb, aku tengok kau buat kerja elok je. Pikir la masak-masak dulu.."

"Setahun je lagi.. Tahan je la.. Rugi you penat-penat belajar 5 tahun.."

"Ok. So what's your plan after this?"

"Kalau quit sekarang nak buat kerja apa? Boleh ka cari kerja lain dengan sijil tu?"

"Aku pun rasa nak quit ar bro. Ape plan kau lepas ni? Kalau ade plan best, bagitau la aku sekali. Boleh aku join."

"Sabar la banyak-banyak.. Tahan je la setahun lagi.. Bukan you sorang je stress.. Semua orang pun stress.. Kerja lain pun stress.."

"So you have finally decided? No matter what you do, we will support you. We wish you all the best."

"You're quitting? Why? Oh, okay.. Just make sure you have a proper plan after you quit. Wish you all the best."

"Sayang la penat-penat you belajar.. Sia-sia je you spent 5 tahun kat medical school.."

"Itu la.. I pun rasa macam nak quit. Tak best la kerja ni.. Tapi kalau I quit I nak buat ape? You nak buat ape?"

"Orang lain semua boleh buat.. You pun mesti boleh buat."

"I suggest you habiskan housemanship you dulu. Lepas tu you nak quit, quit la."

"Aku takde comment. Aku taknak menyokong atau membangkang keputusan kau. Just confirm what you really want, and do it. If you really want to quit and follow your dreams, then so be it. Just make sure you have a proper plan."

I'll add more if I remember any more.

Friday, 23 March 2012

What should I do after I quit?

There are tons of things you can do after you quit. You can do another job, you can take another degree, or you can do both. Just follow your dreams! Be an artist, or a musician, or a racing driver, or Batman, I don't care! Just do what you really want. Cos I believe that if you have the passion for something, then you will definitely succeed in whatever it is that you 're doing. Skills can be acquired through experience. Passion is something that you either have or don't have.

The most common question that pops out whenever someone wants to quit is "What can you do with your MBBS degree if you don't complete your housemanship?"

Can I be a lecturer? - No, most institute require that you have a relevant degree in whatever it is you're teaching. And if you wanna teach in medical school, then most institute require that you have at least 1 year experience of working after getting your permanent license to practice. Which means that you have to finish your housemanship, and be an MO for at least 1 year.

Can I start a business? - Sure you can! You don't need a degree in business or finance just to start a business. If you have enough money to start a business, and you have the passion, then just do it!

Can I be an artist/dancer/policeman/Batman/etc - these sort of jobs doesn't require a degree. It requires passion. You think Picasso have a degree in arts? You think Batman have a degree in crime-fighting? You think Hitler have a degree in world-domination? No they don't. But they like what they're doing, that's why they are able to succeed.

What I'm trying to say is, don't get put off by those who question you on what can you do. Show them what you can do instead. Show them that you're brave enough to follow your dreams and succeed, while they're still stuck with the job they hate every single day.

So what am I going to do? Ideally, I would like to follow my dreams and become an engineer. But I have a girlfriend, and she's already 24 this year, and we've been a couple for more than 4 years. So I can't just take another degree and remain jobless for the next 4 years. I want to marry this girl.

So I'm planning to take a short 1-month course at NIOSH (National Institute of Occupational Safety and Health) and become a SHO (Safety and Health Officer). The pay isn't much, but it should be enough. They say starting pay is around RM2-3K for beginners (RM3-5K if you work offshore), not including overtime. And once you've worked for 3 years, you're gonna get a 'green book', which is to certify that you're a competent SHO. Once you get the green book, your salary will increase to RM5-7K (RM12-20K if you're working offshore with an oil & gas company). That's not too bad isn't it? It's not my passion, but at least it's not the job that I hate.

Once I have enough money, I'm gonna start a business. Perhaps a restaurant by the beach. Something like Chili's, but a bit smaller, and it's gonna be al fresco. Man, that'd be nice.

What about you guys? What's your plan?

How to quit?

Now that I have decided to quit, how should I do it? Should I slam the resignation form in front of the Pengarah like a boss and shout "I fucking quit! Fuck yeah!", or should I go through the troublesome process of submitting the 1 month resignation form and then suffer for another 1 month?

Well, I've been asking around, and it seems that there are a few options available for me:

1) Continue my housemanship - as advised by pretty much everyone. Which part of "I want to quit!" do they not understand?

2) Submit a 24-hour resignation notice (Notis peletakan jawatan) - the most bad-ass way to quit your job. But I have to pay them my one month salary, which is around RM3600. And if you do quit, the next time you want to apply to become a houseman again, they will hire you based on a contract basis. Meaning they can send you to wherever they want you to go (anywhere within Malaysia that is, duh), and they can terminate you at any time if they're not satisfied with you.

3) Submit a 1-month resignation notice - you don't have to pay them a month's worth of salary, but then you have to work with them for another 1 month. I can't even bear to see the hospital for just another day, so this option's not for me. The contract basis applies just like option No.2 as well.

4) Unpaid leave (Cuti tanpa gaji) - this was my initial plan, to take a 6 months leave and use that time to get another job. Not that I plan to return to work as a houseman after 6 month, but this option seems to get the least objection from my girlfriend and my parents. Oh yes, I do have a girlfriend, hence the mess I am in now. If I don't have a girlfriend, I would've just quit and take a Degree in Automotive Engineering. Which means another 4 years of studying and not getting paid. I'm planning to marry her in a year or two, so I can't afford to continue studying. I need a job. And I need to pay for my car as well. That's RM800 per month. So I cant afford to be jobless for the next 4 years. Anyway, I was not entitled to get the unpaid leave. I have to work with them for at least a year, and even if I do that, they can only give me a maximum of 30 days of unpaid leave. That sucks.

5) Missing in action (Tidak hadir bertugas) - this is my current plan. According to the admin people, if I don't show up for work, then they're just gonna stop paying me my salary. When I feel like working again, I can just show up for work, and then they'll start paying me again. I don't have to be rehired on a contract basis. But of course it won't look nice on my work record. If I show up for work again (which I will never do), they will take disciplinary actions (most probably just an extension for that current posting, which I'm pretty sure I'm going to get anyways). **Update: Do not choose method 5 if you want to seriously quit for good. They'll send you letters, call you, and stuff.

So there you go, some of the options available if you're planning to quit your housemanship like I do. Feel free to add more info if you have any.

Why quit?

Why quit? It's a noble job. You can now put the title 'Dr.' in front of your name. The pay is good. The job's secure. There are no risks. Everyone respects you.

Well, you see, I never had the intention to become a doctor in the first place. I got 8A1s in my SPM. You know what are the subjects that I didn't get an A1? Bahasa Melayu, Pendidikan Islam, and Biology. Now wasn't that quite obvious that anything related to living things and the human body is not of my interest? I got a freaking A1 for Sejarah, the most boring subject known to mankind (at least to me), but I didn't manage to score in Biology. Now doesn't that show just how much I hate Biology? My real passion is cars, and I wanna do something that's related to the automotive industry (not a car salesman though). So why did I become a HO in the first place?

Well, I got good results in my high school exam, and also in my matriculation college, and I was young and unsure of what to do, and my parents were pushing me to do medicine. And it's not just my parents, everyone else practically had the same thought. They all had the impression that if you have good grades, then you must become a doctor. Other jobs are rubbish. Other jobs will get you nowhere. Other jobs wont make you rich. Other jobs are full of corrupt people. Other jobs you will be treated like shit. Only doctors can get a decent salary. Only doctors have the most noble job in the world. Only doctors are respected.
Those whose parents or siblings are doctors, they will say "Your mom and I are doctors, even your brother is a doctor, therefore you must become a doctor too!"
And those whose family member aren't doctors, they will say "We never had a doctor in our family. Therefore you must become one and make our family proud!".

If you don't take up medicine, then you will be shunned by your family. Your parents, your grandma, your neighbors, your aunt who never gave a shit about you, your cousin who never spoke a word to you, all of them will say "He got such good grades, why didn't he take up medicine? It's such a waste. He's a shame to his family. He's making a mistake. He's gonna regret it. What was he thinking?"

You see what's wrong with people nowadays?

I know it's a bit too late for me, since I already finished medical school, and I've worked as a houseman for 7 months. But it's better late than never. I definitely do not want to spend the rest of my life doing something that I absolutely loathe every single day.

Anyway, you guys might be thinking, why didn't I quit when I was in medical school?
Let me explain. You see, medical school is like a quicksand. From a distance, it looks safe. It looks harmless. You thought "I definitely could make it through even though I'm not really interested to cross that sandy area. What's the worst that could happen? Might as well give it a try."
So you step into the quicksand, and you slowly started sinking. By this time, your thoughts would be something like "Oh dear, this sand is a bit too soft. It's quite difficult to walk in this sand. But I think I can manage."
So you keep on going until the sand is up to your waist, and you're halfway across the quicksand. And now you're thinking "Shit, I'm in deep trouble now. But I've already made it halfway through. No point turning back now. I must go on."
And eventually the sand is up to your neck, by which time you're thinking "Fuck, I'm gonna die. I never should have stepped into the quicksand in the first place. But there's nothing I can do now."
So by the time you realize that you've made the biggest mistake of your life, you're already engulfed by the quicksand.

And it's the same story with everyone around you. Whenever you want to quit, they'll say "Come on, you've just started your first year! You should at least give it a try! You might like it after you get used to it!"
And then "You're already in your second year! Next year will be the clinical years! You cant give up now! Maybe theory isn't your thing, but you might like the clinical years!"
And then "You're halfway through! You can't give up now! You already spent 3 years here. All of those years will be a waste if you quit!"
And then "It's already the final year! You can't quit now! At least finish your exam and get your degree first! You've come this far, you must go on!"
And then "You already got your degree. At least give housemanship a try. Don't just give up. You should at least try first!"
And then "You can't quit your housemanship! At least finish these 2 years and get your full license to practice!"
And then what? "You can't quit now! You've come this far! All of your efforts will go to waste! You already got your full license to practice, so now you must get a Masters degree and specialize in something!"
It's a never ending process. No one will support you when you want to quit. No time seems to be the right time for you to quit. Everyone would just tell you to keep holding on. If I really wanna hear those words, I would've just played Avril Lavigne's "Keep Holding On" repeatedly on my mp3. At least she sounds like an angel.

And here's my favourite part (by 'favourite', I mean the one I hate the most):
"Everyone else can do it, so can you!"
So what? If everyone is a rapist, so I should become one too? Not that I mind, but you get what I mean.

Anyway, I hope that explains why I wanna quit my job now. It might seem too late, it might seem like waste, but it's definitely what I want to do.
I'm not gonna tell you guys the stresses of being a HO that made me wanna quit, cos I'm pretty sure you guys have experienced it yourself. For the HOs at least. And other houseman blogs out there have already elaborated the stresses of being a HO in detail, so look 'em up.

An introduction

Okay, hi. Let me start by introducing myself.

I'm Danny, 24 years old, and I'm currently working as a houseman / house officer (HO) / junior doctor / Pegawai Perubatan Siswazah UD41 (my official job title) in one of the government hospitals in the state of Selangor. Despite the various job titles, they are all just fancy names for a government slave.
7 months into the job, and currently in the Surgical posting, which is my second posting. I was previously in Paediatrics.

So, from the title of the blog itself, you should be able to guess what are my current intentions. Yes, that's right, I wanna quit my housemanship. Why? How? My future plans? I'll explain all of those in other posts later.
Right now, I just wanna tell you guys the reason for me creating this blog. When I decided that I wanna quit my housemanship, I've been searching around the net looking for other career prospects, and what can I do with my MBBS degree. I noticed that there isn't much info as to what I can actually do with my degree without completing my housemanship. There are tons of blogs written by housemans out there, full of rants, but none of them have plans of quitting. And even if they say they wanna quit, they never actually did it. So here I am, filling the need for a houseman blogger who will actually quit his job, and update you guys on whatever happens next. So HOs out there who have plans of quitting, bookmark this page and follow my updates! Not that I'm encouraging you guys to quit, but I'm merely trying to show you guys that quitting housemanship is not the end of everything. It's just the beginning. Whether it's the beginning of your success or your downfall, depends on what you do after you quit. Let's hope my case is the former.

Anyway, as of today, I have officially been missing from work for the past 10 days. Of course I've informed my colleagues and the HO leader so that they could find someone to replace me. They were kind enough to remove my name from the daily roster so that the medical officers (MO) and specialists will not question my whereabouts. I still haven't officially quit my job yet though. There are a few options for me other than submitting a resignation letter, one of which includes being missing in action (MIA) from work. I'll explain all of these later as well.

So stay tuned my fellow HOs!

**To those of you who are not from this country, housemanship is the same as doing your residency. It's a compulsory 2 year service whereby you have to undergo 6 postings which are: Paediatrics, Medical, Surgical, Orthopaedics, Obstetrics and Gynaecology, and Emergency (in some hospitals, the Emergency posting might be replaced with Anaesthesiology).